GIC chief takes responsibility for 'havoc'

Wednesday

Jan 31, 2018 at 6:37 PMJan 31, 2018 at 6:43 PM

By Katie Lannan State House News Service

BOSTON − After a fierce wave of backlash to its move to limit the health plan offerings for state employees, the Group Insurance Commission's executive director told lawmakers Wednesday she accepts accountability.

"Though unintended, I now understand full well the concern, confusion and havoc that have ensued," GIC executive director Roberta Herman said at a Senate oversight hearing called after the commission voted two weeks ago to consolidate its state employee health plan offerings by dropping three of its six carriers.

A vote to reconsider that decision is set for Thursday, and Herman said the GIC plans to "put forward an option that involves the inclusion of a larger set of carriers, including all qualified incumbents." She did not go into detail on what that option would look like.

Senators participating in the hearing said they were encouraged the GIC would reconsider, but still had questions about how the decision was made.

Senate Ways and Means Chairwoman Karen Spilka said the move left thousands of municipal and state workers "feeling alienated and, frankly, unappreciated, and understandably so."

In a series of public hearings the GIC has held since its Jan. 18 vote, Herman said she has learned that the proposed changes caused "overwhelming anxiety." She said she looks forward to expanding outreach efforts to unions, lawmakers and other stakeholders.

GIC officials have previously said their goal in restructuring was to limit new out-of-pocket costs for enrollees.

Michael Heffernan, Gov. Charlie Baker's budget chief, said the consolidation would have led to over $20 million in savings for fiscal 2019 and either saved GIC members money or reduced increases in premiums and other out-of-pocket costs. It would have provided members with comparable coverage and allowed them to keep their doctors and networks, he said.

"I acknowledge today that the GIC, despite its best efforts, was not able to effectively communicate the likely benefits of this consolidation to its subscribers and their families in advance of that vote," he said. "We know that health care coverage is very important, and a sensitive topic for all of our employees and our retirees, and as the past two weeks underscore, any proposed changes need to have a stronger and clearer communication and provide the opportunity for public and stakeholder feedback."

As secretary of administration and finance, Heffernan holds one of the 17 seats on the commission. He said he voted for the consolidation, and the Tufts Navigator plan that covers his family was among those that would be dropped.

Heffernan said yes when Sen. Donald Humason -- who gets Unicare insurance through the GIC -- asked if he knew when making the decision he would be voting to change his own plan.

Herman, who said her family is enrolled in a Unicare Plus plan, testified before the group of senators for about an hour, walking them through the process that led to the Jan. 18 vote and fielding questions about next steps.

The agenda for the commission's Thursday morning meeting includes reconsideration of the Jan. 18 vote "to reduce the number of insurance carriers," "discussion of options" if the reconsideration passes, and a vote on a "Decision on insurance carriers for contracting."

Herman said she could not predict or determine the meeting's outcome, and said she still believes the commission will be able to meet necessary deadlines before its open enrollment period begins in April.

"We wouldn't put forward an option that we did not think we can execute," she said.

"It's a decision that to be frank has generated more outrage and consternation from constituents than any issue that I can remember over the last, literally, many, many years," Spilka said.

Sen. Cindy Friedman told Herman she was "really looking for how we put trust back into the system." Friedman has filed legislation that would require the GIC to give the Legislature 90 days notice before making any major health insurance changes.

The GIC went through a "highly competitive, rigorous and data-driven procurement process" to select its carriers, Herman said. She said the commission was regularly updated in open meetings, but the Operational Services Division's procurement policies forbade GIC officials "from communicating specific details of any designated changes until the commission voted on January 18."

The 8-5 vote eliminated the Massachusetts-based Harvard Pilgrim Health Care, Tufts Health Plan and Fallon Community Health as carriers, leaving GIC members with the choice of UniCare, Neighborhood Health and Health New England.

A subsidiary of Anthem, Unicare is headquartered in Indiana.

"Speaking for our 200 Massachusetts-based UniCare employees as well, I have grown concerned by some of what is being said about our company," Unicare regional vice president Robert Sorrenti said in a letter to Spilka. "Some of the public comments would lead one to believe we have no existing relationship with the GIC. This could not be further from the truth."

Sorrenti said UniCare has served GIC members for 30 years, and the UniCare state indemnity plan has the largest share of GIC members enrolled, with 173,000. He said the Unicare plan "has been the fastest growing health plan offered by the GIC, driven by consumer satisfaction," and offers access to all providers in Massachusetts.

Jim Durkin of the American Federation of State, County and Municipal Employees said the January vote was "a symptom or manifestation of much larger problems that have existed for far too long" at the GIC, including "steady and relentless cost shifting to workers in the form of higher rates, and more and larger co-payments and deductibles."

According to SEIU Local 509, the consolidation meant 47 percent of active members and 62 percent of dependents "would have been thrown off" their health plans. In prepared testimony, the union's president Peter MacKinnon told of two members "thrown into chaos" because of how the change would affect their children.

One, a Department of Children and Families social worker, has two children with autism who need weekly therapy and go to a clinic in Wakefield that accepts her Harvard Pilgrim insurance, but not the three GIC plans that would remain, MacKinnon said.

He said a case manager at the Department of Transitional Assistance has a teenage son with hypoplastic left heart syndrome, whose care is covered by her Fallon insurance, but has been told by the other plans that they don't cover her son's specific issues.

"She told us she was worried about the 'harsh family decisions' she would have to make if her health plan was taken away," MacKinnon said.

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